AB0426 THERAPY WITHOUT GLUCOCORTICOIDS IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS
Authors: A. Mesnyankina, E. Aseeva, N. Nikishina, A. Lila, T. Popkova
Journal: Annals of the Rheumatic Diseases (2022)

Background The effectiveness of glucocorticoid (GC) therapy in SLE is beyond doubt and has been confirmed by the experience gained over many decades of their use. However, with prolonged use of GC, even in low and medium doses, there are many problems. In particular, the development of organ damage associated with GC significantly worsens the prognosis, leads to a decrease in the quality of life, social adaptation. Currently, attempts are being made to use therapeutic programs without the use of GC or with their appointment in minimal doses. Objectives Achieving stable remission in patients with SLE. Cancellation of oral GC or the use of therapy without GC in patients with SLE. Methods 3 clinical cases. Two patients (N1, N2) had a combination of SLE with Sjogren’s syndrome with predominantly musculoskeletal syndrome. In these patients, severe organ lesions (lupus nephritis, vasculitis, central nervous system damage) were excluded. SLEDAI-2K in these patients was 9 and 8 points. Both patients had a decrease in C3, C4 complement component, ANA positivity, arthritis, hematological disorders. In N2, an increase in at to ds-DNA was determined. Therapy with oral GC, immunosuppressive drugs was not carried out in them. Patient N3 with lupus nephritis (hematuria, leukocyturia), exudative pleurisy, polyarthritis, high immunological activity (SLEDAI-2K - 16 points) was prescribed GC at a dose of 2 tab per day. Creatinine and urea were within normal limits. The patient had high immunological activity: low C3, C4 complement, at to dsDNA 200 IU/ml, ANA positivity (1:1280). Due to the presence of lupus nephritis, the patient received mycophenolate mofetil 1500 mg per day. All patients received double anti-B-cell therapy with the sequential use of Rituximab (RTX) 1000 mg intravenously in patients N1 and N2, and N3 at a dose of 2000 mg per day with premedication of 6-methylprednisolone at a dose of 250-500 mg intravenously. After 1-3 months, belimumab infusions were started at a dose of 10 mg/ kg / month. The observation period is 1 year Results Anti-B-cell therapy allowed patients to be treated without oral GC. A patient with LN (N3) was prescribed low doses of GC at the time of initiation of therapy with RTX, however, they were subsequently completely canceled by the 6th month of therapy. Clinical remission of the disease was achieved in all three patients. Clinical manifestations of the disease were stopped. SLEDAI-2k was 0-2 points due to minor hypocomplementemia (Figure 1). No new irreversible organ damage and relapse of the disease were registered. Patients continued to receive monthly infusions of BLM, there were no repeated courses of RTM. The patient with kidney damage continued to take MM. Figure 1. Conclusion Consistent therapy of RTX and BLM allowed to achieve not only a high clinical and immunological effect, but also the possibility of reducing and even abandoning the oral dose of GC, which is consistent with the concept of “Treat to target” in SLE. In addition, all patients were closely monitored by a rheumatologist once a month, which was partly achieved thanks to monthly infusions of BLM, which were carried out in the clinic. Disclosure of Interests None declared